1 January 2017 Changes

The main changes relate to the publication of Doctors information on the AHSA and participating funds' provider searches.

To facilitate the changes to the business rules the Provider Registration (Provider Details and Direct Credit Authority) form has also been updated. All registrations received on or after 1 January 2017 must use this new form. If an old form is used, the registration will be automatically rejected and you will be requested to complete the new form.

What are the changes to the Access Gap Cover Billing and Business Guidelines?

In relation to this change, the following business rule has been deleted:

DOES THE FUND PROVIDE MY NAME TO ITS MEMBERS?

Unless you indicate by marking the appropriate box on the ‘Provider Details & Direct Credit Authority’ form (Attachment 3) that you do not wish to be placed on our listing of doctors participating in the Access Gap Cover Scheme, your name, practice location and/or billing contact details and specialty(s) will be published on a publicly available doctor listing, provided to GP's and/or given to health fund members over the phone.

Where you have advised AHSA that you do not wish members to be informed of your participation, this request will be honoured.

Fund members will be advised to contact you prior to their admission to determine whether in their case, you will be opting to bill according to Access Gap Cover, and if they will incur any out of pocket expenses.

And the following business rule has been added:

Collection, disclosure and use of information provided

As a condition of your Access Gap Cover registration and making a claim under the Access Gap Cover scheme, you agree that AHSA and AHSA participating funds may in their discretion:

Collect information from your registration form and your other communications with AHSA and AHSA participating funds (including, without limitation, forms and communications received before this condition came into effect and information from claims that you submit). This includes personal information (such as your name, practice address, and other contact details); your field of practice and additional qualifications or specialties, and information (including past claims data) relating to the charges you have rendered, the services that you provide (including where you operate and your surgical partners) and your participation in the Access Gap Cover scheme (together, "the information").

Disclose the information and other information about you to the public, including members of AHSA participating funds and referring doctors, including for the purposes of identifying Access Gap Cover providers, and setting out information relating to the charges rendered, quality of service and statistical information relating to your participation in the Access Gap Cover scheme.

Use the information for internal statistical analysis.

When does the new rule take effect?

The rule changes take effect from 1 January 2017.

Why have you changed the business rule?

AHSA participating funds would like to be able give their members more useful information when choosing a doctor. In an effort to provide more transparency in relation to information such as medical charges and patient gaps, AHSA is introducing a new business rule to Access Gap Cover entitled ‘Collection, Disclosure and Use of Information Provided’.

AHSA participating funds see this change as one step towards empowering members/consumers to make an informed decision when choosing a specialist.

What if I do not want my details publicised?

If you have previously advised that you do not wish to have your details published, AHSA will not publish those details if you no longer participate in the AGC scheme. However, if you continue to participate in the scheme and submit a claim under the scheme after 1 January 2017, your details will be published.

What happens if I continue to use Access Gap Cover (i.e. make a claim) after 1 January 2017?

If you participate in the Access Gap Cover scheme after the new rule comes into force:

your name, practice address, specialty and other contact details will be made available on the AHSA and participating funds' web-based doctor searches; and

AHSA and participating funds may also publish information relating to the charges that you have rendered, the services that you provide and your participation in the Access Gap Cover scheme.

When will the new schedule be available?

The new schedules will be available on the AHSA website by COB 23rd December 2016.